Dental Services Part of Medicaid Transformation

This bill would provide capitated contracts for dental services to Medicaid and NC Health Choice recipients. Consistent with the changes that took place in Session Law 245, the Department of Health and Human Services (DHHS) will enter into capitated contracts with at least two prepaid dental plans for Medicaid and NC Health Choice recipients. All contracts will include dental services statewide to all 100 counties, be prohibited from sub-contracting and reimburse providers on a fee-for-service basis. At least 85 percent of the contracting fee shall be used to offset the cost of providing direct patient care. No more than 15 percent of the contracting fee may be spent on administrative costs. The bill also includes operational metrics demonstrating program success.